Individual
DR. MICKEY JOE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, MS, PSY.D.
Contact information
Practice address
198 E CENTER ST, MOAB, UT 84532-2430
(435) 259-6131
(435) 259-5369
Mailing address
3310 SPANISH VALLEY DR, MOAB, UT 84532-3636
(801) 953-3113
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
5329261-6006
UT
101YP2500X
Professional Counselor
Primary
5329261-6010
UT
Other
Enumeration date
03/18/2006
Last updated
11/09/2009
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